PURPOSE: Routine scheduling of patients with COPD to out-patient clinics, negates the nature of a chronic disease with variations and exacerbations. Care on-demand could be more (cost-)effective. To determine the effects of patient initiated on-demand access to out-patient consultation on health status and use of COPD-related healthcare resources, in comparison with standard out-patient scheduling initiated by the pulmonologist.
METHODS: 78 COPD-patients were randomized to standard visits or care on-demand. The Clinical COPD Questionnaire (CCQ), St. George’s Respiratory Questionnaire (SGRQ) and the Short Form-36 (SF-36) were used to measure health status at baseline and after two years. COPD-related health care utilization was assessed as visits to the general practitioner (GP) and pulmonologist, hospitalizations and the use of medication. The main outcome measure was change in CCQ total score.
RESULTS: Since drop-out was considerable, health status could only be analyzed in 52 patients. Health care utilization, electronically determined, was available for 77 patients. Baseline characteristics were similar in both groups (mean age 70±8 years, 70% male, FEV1%predicted 45±13). The mean increase after two years in CCQ total score (indicating decline in health status) was 0.30±0.62 in the on-demand group and 0.57±0.82 in the control group (difference -0.30 95%CI: -0.68; 0.07 p=0.11). Similar results were found in all CCQ domain scores, with statistically significant differences in favour of the on-demand group in symptom and mental scores. SGRQ scores increased in both groups as well (indicating deterioration of health status), although differences were not significant. Results for the SF-36 were inconsistent and insignificant. The median number of visits to the GP were 4.0 in the on-demand group and 6.0 in the control group (p=0.002). Although not significant, the on-demand group also had fewer visits to the pulmonologist. Number of hospitalizations and use of clinical medication were equal in both groups.
CONCLUSIONS: This pilot study indicated that after two years outpatient clinical care on-demand resulted in less decline in health status and fewer visits to the GP and pulmonologist.
CLINICAL IMPLICATIONS: Our study shows that outpatient clinical care on demand could be (cost-)effective and results in less decline in health status in COPD patients.
DISCLOSURE: The following authors have nothing to disclose: Anne Hesselink, Anne Hesselink, Steven Uil, Huib Kerstjens, Jan Willem van den Berg
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